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The aetiology and pathophysiology of alcohol dependence are complex, derived from genetics, parenting, peer and societal norms and rules, pharmacology and mental health comorbidity. This chapter explores some of the contributing factors that make alcohol dependence a more complex phenomenon than one merely of personal choice. It explores the various aspects of family history that contribute to the heritability of alcohol use disorders, and summarises relevant social and psychological factors. It then provides a nuanced understanding of the pharmacological rationale underpinning withdrawal and relapse prevention treatment, including an understanding of the role of GABA, glutamate and opioid systems. The chapter concludes by highlighting the ways in which patients with psychiatric disorders may be at greater risk of alcohol use disorders. In doing so, consideration is given to trauma-informed principles of care in light of the high prevalence of childhood trauma in this group.
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